Good morning.
My name is Dr. Alexander Shtilbans,
and I'm a movement disorder neurologist.
Today, we're going to be talking about updates and treatments
of movement disorders.
Specifically, we're going to be talking
about benign essential tremor, dystonia,
and Parkinson's disease.
Now, a couple of words, before I introduce him,
just a minute, I want to mention about tremor, in general.
And, as you know, the tremor can have different faces.
It could be a tremor at rest, when
you're sitting doing nothing, and your hands start shaking.
That's typically seen in Parkinson's disease.
You could also have an action or postural tremor,
and meaning when you're reaching for something
or when you're holding a cup of water.
And that could be one of the few things,
including benign essential tremor, dystonic tremor,
enhanced physiologic tremor, and neuropathic tremor, as well.
So the treatment for these kind of tremors are different.
And there's also combination tremor,
which is very rare when one has a stroke in the low portion
of the brain stem.
You could have tremors at all occasions,
at rest, and with action, and so forth.
So the tremor is notoriously hard to treat with medications,
I'll be honest with you.
And you might have experienced it on your own.
So the medications we have for resting tremor and Parkinson's
disease, mainly we'll talk about that briefly later,
but now, the levodopa, the main medication,
can improve the tremor, but might not.
The benign essential tremor, so let's talk about that.
It's treated traditionally with these medications.
Now these medications, except for the DBS,
this is a deep brain stimulation surgery.
So these four medications been around for ages, ages.
And they all are generic.
So Primidone, it's anti-convulsant, used initially
for seizures, is used for benign essential tremor.
Propranolol used as well.
Topiramate is a third-line therapy, can be added on.
Benzodiazepines could just calm you down,
if you have enhanced physiologic tremor, so that can improve it.
So these are the existing medications.
And there is a limit of what you can achieve,
in terms of the improvement in your tremor,
with these medications.
The ethanol-like medications, there
is one in clinical development.
It's called Xyrem.
And we'll talk about it a little bit later.
So as far as the clinical development,
the new trials aimed to find medication
for benign essential tremor.
Unfortunately, we're going to be passing that stage pretty fast,
in a sense that, of the stage of the presentation.
There is nothing really going on.
This is the only study that I found that was completed.
It was phase 2 trial of the T-type calcium channel blocker.
And this is the data showing that, in the baseline, that's
the spiral analysis.
And that's another way.
And in 28 days after having taken
that experimental medications, you
see the spiral analysis improved, in both,
here and here.
However, the phase 2 study did not really reach endpoints.
That the difference wasn't statistically significant.
However, it's phase 2.
So they are going to do phase 3, probably,
because that's where you really know whether it's efficacious
or not.
But apparently the efficacy-wise, statistical
significance was not achieved on the small number of patients
they used in this study.
So we'll be watching out, because that's yet
new development.
And the picture of what essential tremor looks
like-- you have you might have seen it,
but I'm just going to play it for you.
Whoops.
Um, doo, doo, doo, here.
So that's action tremor.
And that's in someone who has deep brain stimulation surgery.
So example of-- you see, stimulation is on.
And the person is able to better pour water from one cup
to another.
And certainly tremor subsides.
And we'll play that video again so you better understand.
So this is in someone who--
we'll have more videos, later on but--
this is someone who has undergone deep brain
stimulation surgery.
And let's play it again.
So that's off, stimulation is off.
And then, doctor turns it on.
And that tremor improves dramatically.
So that's the effect of the deep brain stimulation surgery.
I'm sure Dr. Kaplitt will tell you more about it.
But this is just an introduction to the point
that I'd like to make, that, if your tremor is severe,
it's unlikely that it will be resolved with medications.
And deep brain stimulation surgery
and some other new techniques, the ultrasound techniques,
would be the way to go about that.
So on that note--